POSTAGGRESSION METABOLISM - STATE-OF-THE- ART

Objective: Selection of important results in pathophysiology and patho biochemistry of the surgical patient. Sources: Anglo-American and Germ an literature since 1988. Selection criteria: Importance of reported r esults for the understanding of superior interactions. Results: The te rm 'postaggression' syndrome was introduced on the basis of earlier ob servations regarding the pathophysiology of the surgical patient. More recent results which addressed pathobiochemistry, and which had been obtained by methods of molecular biology, led to the new definition as systemic inflammatory response syndrome (SIRS). Knowledge on metaboli c changes which are associated with SIRS increased significantly in th e field of protein and carbohydrate metabolism. Concerning the clinica ly important phenomenon of protein catabolism, it is possible today to differentiate between changes in protein synthesis and protein degrad ation. The time period which had passed since the underlying trauma an d the variable responses of different organ systems were recognized as important variables of catabolism. The ongoing question regarding pos sible mediators of protein catabolism still remains unanswered. Releas e of cytokines which can be observed in SIRS appears to play only an i ndirect role. The small bowel, which is important for the general path ophysiology of SIRS, gained a central position in amino acid metabolis m (especially glutamine metabolism). A new aspect of carbohydrate meta bolism was found in the liver. The accelerated cycling of glucose mole cules between glucose, glucose-6-phosphate, and glucose (glucose cycli ng) seems to contribute to the increased energy expenditure found in S IRS. Conclusions: Use of new methods in in vivo and in vitro research significantly expanded the knowledge on pathophysiological and pathobi ochemical mechanisms in SIRS. Future research activities should tie to gether these individual mechanisms into the complex network as it pres ents to the physician during clinical routine.